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General NPI Number Information
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NPI Number | 1780854760
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Entity Type | Individual
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Provider Name | STEPHANIE ANN PETERSON PMHNP
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Gender | Female
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 21449 ROUGHOUT RD
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City | REDDING
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State | CA
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Zip | 96003-8209
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Country | US
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Telephone | 530-262-7025
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Fax |
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Provider Business Mailing Address
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Address Line | 859 WASHINGTON ST # 203
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City | RED BLUFF
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State | CA
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Zip | 96080-2704
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Country | US
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Telephone | 530-262-7025
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95020435
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 716439
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License Number State | CA
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